Provider Demographics
NPI:1962168831
Name:CLARK, JULIA ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ELIZABETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 411
Mailing Address - Street 2:UNIT 28037
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:650-906-4583
Mailing Address - Fax:
Practice Address - Street 1:PSC 411
Practice Address - Street 2:UNIT 28037
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-8037
Practice Address - Country:US
Practice Address - Phone:650-906-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39144103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent